CategoryReading of the Week

Reading of the Week: The Big NYT Article on Antidepressants & Withdrawal – Our Vioxx Moment?

From the Editor

“Many People Taking Antidepressants Discover They Cannot Quit.”

The New York Times. Front page. Sunday edition.

One of the most read newspapers in the world just ran a story suggesting that antidepressants may be linked to significant withdrawal symptoms. That news article is, well, news. Journalists Benedict Carey and Robert Gebeloff interview a mother of four who says, “Had I been told the risks of trying to come off this drug, I never would have started it.”

istock_000017711523xlargeAntidepressants: small pills but big problem?

This week’s Reading looks at the big article and considers its big implications.

DG

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Reading of the Week: Three Essays on Mental Illness

From the Editor

As stigma fades, we are as a society talking more and more about mental illness. And we are also writing more on the topic.

This week, the Reading features three essays that ask three provocative questions. Does naloxone access save lives? What’s it like to be depressed and in medical school? How do involuntary commitment laws affect the families of those with mental illness?

These essays are very different in part because they reflect very different perspectives on our collective experience with mental illness: the perspectives of providers, patients, and families.

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Enjoy.

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Reading of the Week: Is Lithium Underrated? Preventing Rehospitalization with Bipolar – the New JAMA Psychiatry Paper

From the Editor

From the perspective of the treatment team, a rehospitalization is a failure – a patient returning to the system, unwell again. From the perspective of the patient and her or his family, a rehospitalization can be frightening and humiliating.

How best to keep people with bipolar affective disorder out of hospital? In a new JAMA Psychiatry paper, the University of Eastern Finland’s Markku Lähteenvuo and his co-authors attempt to answer this question – not by using a RCT, but instead by tapping Finnish national databases.

For the record, they find one medication works better than the others: lithium.

800px-central_hospital_of_central_finlandFinland’s Central Hospital: adequate architecture but good data

In this Reading, we consider the new paper by Lähteenvuo et al., and also consider their approach.

DG

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Reading of the Week: Early Psychosis Intervention – Lifesaver? The New Anderson Paper from the AJP; Also, Michael Weinstein’s Burnout

From the Editor

The argument is simple: intervene early and outcomes will ultimately be better.

For people with psychosis, early intervention programs have been tried for more than two decades. In our first selection, we look at a new American Journal of Psychiatry paper considering early psychosis intervention and outcomes. This paper is particularly interesting because it draws on the real-world experience – and 17 years worth of data. (Bonus: the data is Canadian.) The lead author, Western University’s Prof. Kelly K. Anderson, looks at several outcomes.

She and her co-authors conclude that patients had faster access to psychiatrists and used EDs less. More importantly: early intervention was a lifesaver, with the rate of death being four times lower than those who didn’t use the program.

caa58b79-155d-451f-6734f0c9af79d4c2Does Franklin’s comment about an ounce of prevention being worth a pound of cure apply to first episode psychosis?

And in our other selection, Dr. Michael Weinstein writes about his career as a trauma surgeon – and his depression. “I have learned that many of us suffer in silence, fearing the stigma associated with mental illness,” he observes in The New England Journal of Medicine.

Please note that there will be no Readings for the next two weeks.

DG

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Reading of the Week: Do Antidepressants Work? The New Cipriani Study

From the Editor

Last week, I spoke to a patient about antidepressants. “But do they really work?” she asked. While antidepressants are commonly prescribed, many patients wonder about them. That’s not surprising: in popular culture, these medications are often portrayed as risky and unhelpful. Just a few weeks ago, the most popular women’s fitness magazine in the world described fawningly how a woman quit her medications and felt better (“I felt more alive and in control of my emotions with each passing day”). A few years ago, a major study suggested that antidepressants basically match placebo in efficacy; 60 Minutes covered it.

And now there is the new Cipriani et al. paper. “We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder…”

Is this the biggest psychiatry paper of the year? Certainly, it may be one of the most impressive. It took six years of effort. Oxford University’s Andrea Cipriani and his co-authors drew from all available data – published and unpublished, and covering more than 500 trials.

The media coverage has been incredible. The Guardian summarized the paper with the first two words of its article: “Antidepressants work.”

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In this Reading, we look at the big study and mull the big implications.

DG

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Reading of the Week: Rahael Gupta on Medical Students & Depression (& her Depression)

From the Editor

Once—and I have never shared this before—I stepped into the street on my walk home from the library. I knew that the bus hurtling through the night would not have time to stop before colliding with my darkly dressed frame, fracturing my bones and scattering my belongings. I imagined my head hitting the asphalt and my brain banging around inside of my skull, bruising irreparably with each impact. I imagined the bus driver’s horror as he turned off the ignition with shaking hands and leapt out of the vehicle to locate my body. It would be a catastrophe that the trauma surgeons could not salvage. I would die.

Rahael Gupta is many things. She’s a graduate of Stanford University, and also Columbia. She’s a medical student. She’s a self-described optimistic. She’s a marathon runner.

And she’s a person who has struggled with depression.

michigan-med-l-med-student-depression-keyvisual

In this week’s Reading, we consider her essay in JAMA. It’s moving and clever and important.

DG

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Reading of the Week: Prazosin for PTSD & Nightmares – No Better Than Placebo? The New NEJM Paper

From the Editor

It’s like the script of a movie: a doctor seeks a treatment for the nightmares so common in vets with PTSD. He finds an old blood pressure medication that seems to work. Then, after years of use and with some money from a not-for-profit, he does the definitive study, landing a big paper in one of the biggest psychiatric journals.

Dr. Murray Raskind had explained his interest in prazosin simply – he theorized that if he calms the brains of veterans, they would have fewer nightmares. To that end, he sought a medication that would block norepinephrine and found just one antihypertensive that did that, and crossed the blood-brain barrier. And so began a 20-year interest in an old antihypertensive.

But is there a twist in the plot? A new study just published in The New England Journal of Medicine suggests yes. “This 26-week trial involving military veterans with chronic PTSD failed to show a benefit of prazosin over placebo in reducing the frequency and intensity of trauma-related nightmares.”

And, by the way, the lead author of this study is Murray Raskind.

New pill, same old problem?

In this week’s Reading, we consider the Raskind et al. study. We also consider the accompanying Editorial that calls the results: “surprising and disappointing.”

DG

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Reading of the Week: ECT in America – Uncommon, Uneven, and Underappreciated? The New Wilkinson Paper; Also, Cope’s Challenge to Corporate Canada

From the Editor

It’s difficult not to be excited about Bell Let’s Talk. Last week’s event set a fundraising record. Pause for a moment and appreciate how far we have traveled: a major Canadian corporation is promoting mental health awareness, raising millions of dollars in the process, and gathering praise from many, including the Prime Minister. The decline of stigma is seen across the west, with talk of tackling the opioid epidemic in New Hampshire, US, and of bettering psychological interventions in Hampshire, UK.

But how accessible is evidence-based care?

In the first selection, we consider a paper just published on ECT in the United States. Drawing on a massive database, the authors of this Psychiatric Services paper find ECT is used rarely and unevenly. In this Reading, we compare the American data to Canada’s – and draw a similar conclusion.

flag_map_of_the_contiguous_united_states_1912-1959A large country with many people – but not much ECT

And speaking of Bell Canada, in our second selection, we consider a Globe article on CEO George Cope’s recent Canada Club speech. In it, Cope challenges other businesses to implement a mental health strategy. “For business leaders… here’s the call-out: The numbers are self-funding. There’s no reason not to adopt a program in your company.”

DG

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Reading of the Week: AI & Mental Health – Gordon Parker Looks Ahead; Also, Remembering Ronald Fieve

From the Editor

As artificial intelligence advances, what role will computers play in mental health care?

Today, computers touch practically every aspect of our lives – from suggesting books that may be of interest to us on Amazon to helping fly our planes to tropical destinations. But will computers soon help us with diagnosing and treating our patients? Will some parts of clinical medicine be replaced or assisted by computers?

This week, we look at a new paper from Acta Psychiatrica Scandinavica considering AI and care. University of New South Wales’ Professor Gordon Parker sees a role for computers to help humans with diagnosis – but not more. “[R]ather than seeking to develop a computer program that will have diagnostic superiority to an ace clinical psychiatrist, it may be more important to develop programs that complement the psychiatrist’s judgement.”

AI: The next great doctor – or just a pretty face?

And in the second selection, we look back, not forward, and consider the career and contributions of psychiatrist Ronald R. Fieve, who recently passed. Dr. Fieve’s work helped bring lithium to North America.

DG

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Reading of the Week: David Goldbloom on Research & Clinical Practice

 From a Contributing Editor, Colleague, and Friend of the Editor

This week’s selection is a brief paper with long implications. For all of us clinicians who turn to the peer-reviewed literature (either directly or through the filter of Reading of The Week) for guidance on how to help our patients, this paper is worth a read.

It is impossible to stay current on the treatment research results that emerge daily, and we look to those randomized controlled trials published in high-impact peer-reviewed journals for evidence of what works for people with the diagnoses that we find ourselves addressing in the office, the clinic, the ER or the inpatient unit. But who are those patients who sign consent forms to take part in these studies, and how much do they resemble the people sitting across from us?

Great clipboard but relevant to clinical work? 

– David Goldbloom, OC, MD, FRCP(C)
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